by Jonathan Hoffman, PhD
According to Derek (not his real name), an extremely fit-looking 30-year-old corporate manager whose interview follows below, Muscle Dysmorphia (MD) is “perhaps the most serious problem facing gay men aside from HIV/AIDS.” He is not only passionate regarding sharing his own experiences to help others, but also about raising awareness regarding this significant issue for his community.*
A great deal of information about MD and BDD may be found throughout this website. The following interview focuses on MD, as experienced through the eyes of one member of the gay community.
JH: Why do you think MD is such a major problem in the gay community?
D: MD, in my opinion, is the most widespread, under-diagnosed, and misunderstood disease to hit the gay community since AIDS. We are body obsessed. Walk into my gym, or others like it, and you can see the sharp increase in the amount of people taking steroids and other growth hormones. It can affect personal and professional growth and act as a roadblock if you let it consume you. Because being gay can be so focused on looks, it’s often hard to concentrate on other parts of your life, like relationships or work.
The gay world is so competitive about how you look, and there’s a lot of competition out there. I realize that some gay people don’t care about how their bodies look, but I think then it’s something else they get caught up in, like their clothes.
Although I think things are changing, for a long time being gay was associated with being a sissy, weak, and feminine, building your body was a way of proving you were strong and masculine.
I think that what’s happening with MD is a little like HIV/ AIDS was at first in that nobody really recognized what it was, or talked about it. It’s a big problem. That said, not everyone has it. And not everyone has the same level of severity. But I strongly believe that, like AIDS, many people might not know it exists in them, or they think they’re immune to it.
JH: Please discuss why you decided to speak out about the issue of Muscle Dysmorphia (MD)
D: I didn’t associate looking in the mirror so much and being so overly concerned with my body was an illness. Now I realize it is and there is treatment. Also, I’m pretty sure my partner has it and is in denial. It’s all around me. Maybe if I share my story, someone else will realize they have it and can get help.
JH: Do you consider yourself to have MD? BDD? And if so, what does having this condition mean for you?
D: Yes, I think I have MD and BDD because I’m just too aware of how I look and check my appearance, my muscles all the time. I worry that my life revolves around how I look and how I think others rate how I look. I actually turn down social engagements or going out after work, even some job opportunities, because I worry I won’t get to the gym, or the place I am traveling to won’t have a good gym.
If I miss a workout, I think that everything I have worked for is totally gone. I realize that this doesn’t makes sense, but it’s hard for me not to think like this.
JH: How, when, and why, in your opinion, did MD start in your own life?
D: When I came of age and started to read gay magazines, all the pictures were of very good-looking, very fit people, I figured I’d better get going and get into shape too. It started slowly in me, but all of this is very addictive, and it just got worse and worse as time went on.
I can’t remember when I first learned of Body Dysmorphic Disorder. I do, however, remember thinking “this is a real thing?” and “there are other people who are just as unhappy as I am?”
JH: Do you think that having a “perfect” appearance is more of an issue for gay people than for heterosexuals? Why?
D: Absolutely. I’m not quite sure how. But when I talk to straight guys, they always seem so confident to me, no matter what they look like. For me, and I think other gay people like me, my confidence is based on how I look, if I don’t think I look great, my confidence just goes away.
JH: How has MD affected you, your relationships, or your career?
D: I feel like I’m being held hostage by my MD. Moments of confidence and high self-esteem vanish the moment I look into a mirror, no matter how hard I try to turn away. I become obsessed with looking at myself, and come up with creative ways to do so. There have been times when I will record video from my laptop webcam and turn 360 degrees, watching it back and critiquing how I look from all angles. I’ve taken pictures of myself in sexually compromising positions to see what others would see. Any reflection is an opportunity for me to look at myself and become depressed. It can sometimes affect my work performance. As the end of the workday nears, I know there’s plenty I can do to further my career. But that voice in my head says “you have to get to the gym, look at you.” My personal relationships suffer the most. I feel like I often turn down social engagements with friends because I’d rather be working out. And my partner has told me I have to have more confidence in myself, and the way I look. He, and others, have told me that what I see no one else sees.
You describe me as extremely fit, I would describe myself as average. I don’t think anyone would describe me as muscular, or being in great shape. When people always tell me that I look like I work out a lot, I don’t know what to say, it gets awkward.
JH: Are there any characteristic negative ways of thinking about their bodies you believe are common among gay individuals with MD?
D: Pressures of physical appearance, in my opinion, are heightened. Just like women are portrayed as size 0 and 1 in magazines, gay men are portrayed as big and muscular, well defined, strong. And I know so many of those people, like my boyfriend, who is in incredible shape and can’t see it. And they, too, are so extremely hard on themselves. A bucket full of compliments can’t make them stop complaining about their body.
JH: How much awareness of MD or BDD do you think there is in the gay community?
D: Many people have it. I know of many friends, again, even my partner. I’m not saying everyone has the same severity when it comes to MD. But many people don’t realize they have some form of it. They’re in denial. They don’t have a real grasp of what MD is. The word “disease” has other meanings, even to me. I would have never guessed that looking at myself in the mirror, eating right, and working out would be considered a disease.
JH: For you, where does healthy working out/body building and eating right end and MD begin? Do you think this is a particularly difficult question for gay individuals to consider?
D: For me, working out, body building, and eating right ends when you consider, though I have never done so, taking steroids. The line is drawn when you skip the gym and, rather than doing it because your body needs rest, you complain about it to everyone (your partner, your friends) rather than being OK with it. It ends when you turn down social engagements day after day and week after week because you want to be at the gym, and when you’re having such low self-esteem that no one wants to be around you and hear you complain. It ends when your work and professional life is suffering. It ends when you’ve been planning on going to the gym and a hiccup in your schedule simply doesn’t give you the time to do so and you go into a downward emotional spiral. But mostly, the line is drawn when you’re just so unhappy that it consumes your thoughts. I think this is particularly hard for gay men.
JH: Do you think that there needs to be more awareness of MD in the gay community?
D: Like I said, I believe that MD, and BDD, are the biggest diseases to hit the gay community since AIDS. And, like the beginning era of AIDS, the gay community has little awareness. People know that something exists, but there’s just no awareness. In my mind, BDD is the single biggest reason why so many of those in the gay community who take steroids do so.
JH: It has been suggested that MD is associated with poor self-esteem and loneliness, do you agree? What about being suicidal?
D: I would agree. I often have those exact feelings, with the exception of being suicidal. But, for every moment I experience happiness, I can quickly become down if I think about my body.
JH: Similarly, what about emotions like anxiety, depression, disgust, or anger?
D: I get extremely anxious when I don’t go to the gym or can’t make it to the gym. Often, I can get angry and take that anger out on people around me. I often feel feelings of disgust as well.
JH: Do you have any particular suggestions for clinicians working with gay people with MD
D: The main thing is to educate people, when it comes to gay people they might not realize they have it, and it should be remembered that they might have a different connotation of the word disease, as often something sexually transmitted. They should keep in mind that considering this as a problem with their mental health may not make any sense to tem at first, so this has to be worked on very gradually and sensitively.
JH: What about parents or partners of gay individuals with MD, any suggestions for them?
D: Be careful about being too reassuring, because that becomes addictive, the more you compliment them or boost them about their bodies the more they will demand this, and get upset when they don’t get the response they want.
JH: Do you think this is a “closeted” issue, associated with shame, guilt, poor self-image, or embarrassment?
D: This is absolutely a closeted issue. I also think not many people realize that they might have it. It’s a hard thing to admit to doing! People might think I’m a bit crazy. I absolutely feel shame, guilt, and embarrassment, and have a poor self-image. What’s interesting, though, is that no matter how closeted I was, it seeped out externally. I would, at first, keep my thoughts to myself. But every now and then I’d make mention of my discomfort with my body to friends, family, and my partner. Comments would be scarce. But once I opened that door, my thoughts became external and more frequent, to the point where people would tell me to have more self-confidence in myself. And once it started, it was hard to stop. I was always looking for reassurance from others about my body.
JH: Are pressures about physical appearance heightened among gay people to begin with?
D: I would say that, yes, pressures and concerns about physical appearance are heightened among gay people to begin with. With that being said, I suffer from MD and BDD. So maybe, just maybe, those pressures are internal and not necessarily external. Maybe the way that I think others perceive me is not actually how they perceive me.
JH: In regard to MD, in your opinion are there specific body parts that are especially of concern for gay people?
D: I think this varies. For me, it’s stomach, abs, my love handles, hairline, and biceps.
JH: How do idealized images of masculinity affect gay people? Do you think the ideal of being extremely muscled in the gay community is a fad, or can change over time?
D: I think, eventually, the over-muscular and steroid look is going to fade away. Being gay wasn’t accepted, even ten years ago, like it is now. And there is much more support from straight people, even celebrities like Lady Gaga and Barack Obama. Maybe as being gay is more accepted, the need to prove anything won’t be as strong.
JH: Does MD affect your eating habits?
D: I will eat good mainly, when I eat bad I think I cheated and cannot stop talking or thinking about what I did, I relive the memory of it, and it consumes me. I feel like I have done the worst thing in the world possible, like if I ate something with sugar.
JH: Have you ever considered cosmetic surgery?
D: Yes, and I haven’t ruled it out, for my love handles, one of the areas I focus so much on, I wonder if I get that done, would it cure me a little bit? What’s stopped my from doing it is how much it costs, and that it’s an invasive procedure, so I don’t want to rush into it.
JH: What about aging and MD in the gay community?
D: A lot of gay people are especially nervous about aging, I think as I get older, just turning 30, I’m trying to think in a different way, as my goals are changing, I have less time to work out, more responsibilities, have to come to grips I can go to the gym, I want to stay healthy, but need to balance out my life more.
JH: Do you think gay people with MD are open to getting psychological help for this problem?
D: I don’t think many are, they just don’t think it’s a problem, or realize how it’s affecting them.
JH: What are your thoughts or plans regarding how to address MD in your own life at this point?
D: I’m finally coming to the point of really realizing what this is. I’m planning to continue therapy, finding other kinds of exercises, ones that put me in an uncomfortable situations that put me more in touch with myself and my body, looking at my priorities in different ways, it’s very important for me to be self aware, if I want to ask my boyfriend how I look, I should try and hold back, stop myself, if I eat the wrong thing, I want to stop complaining, train myself for, rather than a new muscle, a new reaction.
JH: What can organizations like the International OCD Foundation (IOCDF) do to help?
D: First, they can raise public awareness. I’ve never seen a commercial, PSA, social media about this, I’d probably laugh, but out of nervousness, because it relates to me, even a marketing campaign, like putting mirrors in public places, saying look at yourself, if one negative thought comes to your mind about your body, take this pamphlet. They can go into a heavy marketing campaign for the gay community.
JH: Thank you again for your willingness to share your point of view and participate in this interview.
* This interview was conducted via teleconference, phone, and email. Derek wanted to note that at one point he couldn’t help worrying about how his gym time was being affected by spending time on this interview, but he’s glad he did anyway.
Jonathan Hoffman, PhD, ABPP, is Clinical Director of the NeuroBehavioral Institute in South Florida, and is a member of the IOCDF Scientific & Clinical Advisory Board.